Provider Demographics
NPI:1417105305
Name:HARRISON SENIOR LIVING OF GEORGETOWN, LLC
Entity Type:Organization
Organization Name:HARRISON SENIOR LIVING OF GEORGETOWN, LLC
Other - Org Name:HARRISON HOUSE OF GEORGETOWN, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RICHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-383-4225
Mailing Address - Street 1:110 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2137
Mailing Address - Country:US
Mailing Address - Phone:302-856-4574
Mailing Address - Fax:302-856-3021
Practice Address - Street 1:110 W NORTH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2137
Practice Address - Country:US
Practice Address - Phone:302-856-4574
Practice Address - Fax:302-856-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1068314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000135911Medicaid
DE0000166412Medicaid
DE0000166412Medicaid